Healthcare Provider Details

I. General information

NPI: 1720890239
Provider Name (Legal Business Name): VALERIA IGNACIA BEZAMA JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date: 09/19/2025
Reactivation Date: 10/15/2025

III. Provider practice location address

800 WEST MAIN ST
MONROE WA
98272
US

IV. Provider business mailing address

800 W MAIN
MONROE WA
98272
US

V. Phone/Fax

Practice location:
  • Phone: 360-805-3122
  • Fax: 360-805-9180
Mailing address:
  • Phone: 360-805-3122
  • Fax: 360-805-9180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG61617853
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: